Causes:
Lepra reactions occur in 30–50% of patients with leprosy.
They may occur before, or more often, after the start of treatment. These are sudden responses resulting from the release of immunologically active bacilli or its products leading to localised or systemic symptoms and signs.
Such reactions are responsible for most of the nerve damage, deformity, and disability.
Source
Caused by two clinically indisginguishable organisms: M leprae and M. lepromatosis;
M leprae is an obligate, intracellular parasite -> can't be cultured on normal media.
Grows best at 27 to 34C -> grows on cooler parts of the body.
M leprae multiplies very slowly; generation time is about 12.5 days.
++ /dev/null
Mucus plugs -> lung collapse; can cause proximal bronchiectasis
Treatment:
Systemic prednisilone; ICS will help asthma but not the lung infiltrates
Itraconazole + voriconazole.
Produced by fragmentation of cytoplasm of megakaryocytes in the bone marrow.
Production is regulated by negative feed back involving thrombopoietin.
Normally, platelets are removed by macrophages of the reticuloendothelial system.
Presents with purpura and mucous membrane bleeding.
Purpura can occur when plt count is < 50k.
Presentation is similar to bleeding in vascular disorders.
Impaired production, increased destruction, splenic sequestration.
Disorders of platelet function are suspected in patients who show skin and mucosal haemorrhage despite a normal platelet count and normal levels of VWF.
Platelet count is often normal, bleeding time is prolonged.
| Hereditary | Acquired |
|---|---|
| Glanzmanns thrombasthenia | Myeloproliferative disease |
| Bernard-Soulier syndrome | Renal disease and Liver disease |
| Storage pool disease | Paraproteinaemias |
| Drug induced - NSAIDS / Aspirin |
#autosomal-Recessive defects in GPIIb or IIIa -> defective platelet aggregation.
Presents in neonatal period.
#autosomal-Recessive Defective adhesion and aggregation. Larger than normal platelets.
Presents at birth; mucosal and post traumatic bleeding.
Lack of storage pool of platelet dense granules.
? age of presentation
3. Frontalis muscle - mostly lifts the eye brows.
Within the CNIII nucleus, each muscle innervated by the nerve as a subnucleus.
[!INFO] Unilateral lesion peculiarities
Note: Bilateral eye elevation deficit and ptosis
Isolated oculomotor nerve palsy with pupillary involvement in adults is usually related to compression of the third nerve either by an intracranial aneurysm, typically originating at the junction of the posterior communicating and the internal carotid arteries, or by a pituitary tumor (such as in pituitary apoplexy). Both disorders are life-threatening conditions.
I.e All muscles affected but pupils spared.
Selective ischemia of the central part of the nerve, not affecting the peripheral sympathetic fibers can occur in occlusion of the vaso nervorum. (eg. Diabetes mellitus)
Associated with two rheumatic disorders - Sjogren syndrome and Rheumamtoid arthritis.
[[General Medicine 1#Allergic bronchopulmonary aspergillosis|Allergic bronchopulmonary aspergillosis]] - ? central bronchiectasis
#TODO add image of enthesis
HLA-B27
Synegistic with penicillins used in endocarditis against Enterococcus and streptococcus viridans.
Paralysis usually resolves in about 4 days with complete EMG resolution taking about 6 weeks.
Resolution of paralysis progresses upwards.
No chronic neurological deficits were reported.